Provider Demographics
NPI:1124078746
Name:GARZA, MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:GARZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 W FREDDY GONZALEZ DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7339
Mailing Address - Country:US
Mailing Address - Phone:956-287-2100
Mailing Address - Fax:956-287-2111
Practice Address - Street 1:3521 W FREDDY GONZALEZ DR
Practice Address - Street 2:SUITE B
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7339
Practice Address - Country:US
Practice Address - Phone:956-287-2100
Practice Address - Fax:956-287-2111
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0194208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159406102Medicaid
TX092466405Medicaid
TX159406101Medicaid
TX8K0400OtherBLUECROSS PROVIDER ID
TX159406101Medicaid